Home Health & Hospice Week

Home health agencies can stop stripping supplies costs out of every claim they submit now that the Centers for Medicare & Medicaid Services has isolated the billing glitch involving the charges.

The problem has been hanging up claims since the beginning of the fiscal year. CMS recently instructed the regional home health intermediaries to return to provider (RTP) claims that suspend due to the error (see Eli's HCW, Vol. XII, No. 9, article 1). HHAs must remove the supply lines from the claims and resubmit them for payment.

Alternately, some HHAs have omitted supplies from all claims to avoid suspensions altogether, even though the practice could affect overall prospective payment system rates down the line.

But now it is known that the glitch applies only to claims that are subject to a partial episode payment (PEP) adjustment or a significant change in condition (SCIC) adjustment, a CMS official said in the April 1 home health Open Door Forum.

CMS is working on a fix for the problem, which it should distribute to the RHHIs by mid-May for testing. It's expected to be implemented in June.

But agencies can't afford the extra burden for those months, noted Mary St. Pierre with the National Association for Home Care & Hospice in the forum. Removing supplies from the affected claims is a significant time drain for HHAs, she says.

Meanwhile, CMS also addressed local medical review policies regarding physician certification of home health patients. CMS does not plan to compel physician carrier Trailblazer Health Enterprises and other carriers to change their LMRPs on the issue, a CMS official said.

Trailblazer's policy threatens docs with medical review for claims in which they certify or recertify patients for home health more than three times a year (see Eli's HCW, Vol. XII, No. 8 article "Referrals").

The carriers will not pay for recerts if the physician hasn't seen the patient face to face, the CMS official revealed. But the LMRP shouldn't impact patients' access to home health care, only physicians' payments for recerts, CMS maintained. Physicians should feel free to sign as many recerts as they want, they just shouldn't expect to get paid for them unless they see the patient, the official said.

A home health representative pointed out that despite CMS' insistence that the LMRP is purely a physician payment policy and not a home health coverage policy, the LMRP will affect home health access.

Other topics addressed in the forum include: